Libro Cirugía del Seno Mínimamente Invasiva

Minimally Invasive Sinus Surgery
New Implant Treatment Protocols for the Posterior Maxilla

* Language : English

* Author and Editor : Young-Ku Heo, DDS, MSD, PhD
* Co-Authors
Richard Leesungbok, DMD, MSD, PhD
Jung-Chul Park, DDS, MSD, PhD
Nam Yoon Michael Kim, DDS, MSD, PhD
Jongyub Kim, DDS, MS, CAGS, PhD
Chonghwa Kim, DDS, MS, FICD
Joongmin Kim, DDS, MS, PhD
Hyun-Chang Lim, DDS, MSD, PhD

| Chapter 1 | Understanding the Posterior Maxilla / Jung-Chul Park, Hyun-Chang Lim 
– Introduction / 2
– Anatomy of the posterior maxilla / 3
– Conventional sinus lift techniques / 15

| Chapter 2 | CMI Fixation: Types of Implant Fixation / Young-Ku Heo, Richard LEESUNGBOK 
– Conventional bone density classification / 26
– Heo’s bone density classification / 28
– CMI fixation / 29
– Charting methods of the CMI fixation / 36

| Chapter 3 | Heo’s Sinus CMI Classification / Young-Ku Heo 
– Heo’s classification of Sinus CMI fixation / 43
– Sinus Class I CMI fixation / 44
– Sinus Class II CMI fixation / 48
– Sinus Class III CM/C fixation / 56
– Sinus Class IV CM/C fixation / 56

| Chapter 4 | The SCA Technique: A New Sinus Crestal Approach Technique / Young-Ku Heo 
– New approach to achieve xation in the inferior cortical wall of the sinus / 60
– The SCA technique / 61
– Step by step procedure of the SCA technique / 74
– Key factors for minimizing membrane tearing / 79

| Chapter 5 | Clinical Cases of the SCA Technique 
– Case 1: 8 Year follow-up case of Class III CMI/CM xation in the maxillary 1st and 2nd molar area / Jongyub Kim / 84
– Case 2: Single tooth restoration with a Ti customized abutment supported by an implant with Class III CMI xation in the maxillary 1st molar area / Richard LEESUNGBOK / 88
– Case 3: Delayed immediate placement with Class III M fixation using the SCA technique in the extraction socket of the maxillary left 1st molar/ Chonghwa Kim / 92
– Case 4: Maxillary posterior multiple teeth replacement with Class I, II, and III CMI fixations / Young-Ku Heo / 95
– Case 5: 10mm sinus lifting with the SCA technique in the severely concave sinus floor / Young-Ku Heo / 101
– Case 6: 6 year result of a 7mm sinus elevation with the crestal approach utilizing micro-elevators / Jongyub Kim / 107
– Case 7: Immediate placement with the crestal sinus elevation in limited available bone height/ Jung-Chul Park / 112
– Case 8: 7 year long-term result of immediate placement with crestal sinus elevation/ Joongmin Kim / 116
– Case 9: Class III M xation with sinus crestal elevation and GBR with a Ti mesh / Nam Yoon Michael Kim / 121 
– Class 10: 6 year result of simultaneous implant placement after sinus elevation through the crestal approach with the microelevators in the thin residual bone height/ Young-Ku Heo / 128
– Case 11: Crestal and lateral sinus elevation with SCA and SLA techniques / Young-Ku Heo / 133

| Chapter 6 | The SLA Technique: A New Sinus Lateral Approach Technique / Young-Ku Heo 
– Conventional lateral window technique / 144
– The SLA technique / 146
– Basic procedures of the SLA technique with simultaneous implant placement / 162
– Advantages of the SLA technique / 164
– Complications and management / 173

| Chapter 7 | Clinical Cases of the SLA Technique 
– Case 1: 8-year result of a lateral window opening using a LS-reamer with a semilunar ap / Nam Yoon Michael Kim / 186 
– Case 2: 8-year result of a lateral window opening using an LS-reamer with a small vertical incision/ Young-Ku Heo / 191
– Case 3: CMI implant surgery with SCA and SLA on the posterior maxilla / Richard LEESUNGBOK / 196
– Case 4: Sinus Class III CM and Class IV CM/C xations with SCA and SLA techniques / Jongyub Kim / 204
– Case 5: Immediate placement with SLA technique and small vertical incision / Chonghwa Kim / 212
– Case 6: Simultaneous implant placement with C-reamer and full thickness ap: 5 year follow-up / Joongmin Kim / 218
– Case 7: Immediate placement with sinus Class IV CM/C xation using SLA technique / Chonghwa Kim / 222
– Case 8: Reduction crestal-alveoloplasty with sinus graft / Young-Ku Heo / 226
– Case 9: Vertical alveolar ridge augmentation using a Ti-mesh SLA technique / Jung-Chul Park / 233 
– Case 10: Sinus membrane elevation of a complicated sinus septum area with vertical bone augmentation in severe defect area / Nam Yoon Michael Kim / 239

| Chapter 8 | Scientific Evidences for Predictability of the SCA/SLA Techniques, CMI Fixations, and Loading Protocols in the Posterior Maxilla 
– 8-Year Retrospective Study on the SCA and SLA Techniques, and Sinus CMI Fixation and Loading Protocols in the Posterior Maxilla / 246
– Early Loading of Splinted Implants Supporting a Two-unit Fixed Partial Denture in the Posterior Maxilla: 13-month Results from a Randomized Controlled Clinical Trial of Two Different Implant Systems / 263
– Retrospective Results of Implants for Partially Edentulous Posterior Jaws According to Time Points of Early Loading / 268
– The In uence of Sinus Membrane Thickness Upon Membrane Perforation During Transcrestal Sinus Lift Procedure / 270
– Incidence of and Factors Associated with Sinus Membrane Perforation During Sinus Augmentation Using the Reamer Drilling Approach: A Double-Center Case Series / 279
– A New Technique for Minimally Invasive Maxillary Lateral Sinus Augmentation: a Case Report / 286
– Sinus Bone Grafting Technique Using Special Reamers and Microelevators / 290
– Differences in Implant Stability Associated with Various Methods of Preparation of the Implant Bed: An in Vitro Study / 294
– Comparison of Surgical Techniques to Enhance Primary Stability in the Thin Crestal Cortical Bone and Low-density Bone / 297

Rarely have I seen a textbook with such a wonderful mixture of didactic knowledge, combined with clear and precise clinical procedures and techniques.

Dr.Heo deserves great accolades for doing exactly this.

This fine book uses the orientation of minimally invasive sinus surgery tohighlight the proper way to manage the posterior maxilla. By showcasing various incision designs, in combination with many of his burs that are specifically designed for both lateral and crestal approaches for lifting the membrane, he has added greatly to the ease and safety of performing this procedure.

In addition, the book has many chapters with clinical cases that highlight the proper technique to carry out the recommended procedures.

This, along with very clear and to easy follow diagrams, allows the reader to follow the recommended techniques. It is also nice to see that safety as well as efficiency is built into the burs that are being recommended. This is important for beginners as well as experienced clinicians. The fact that complications are also presented along with ways to deal with them is refreshing to see in a textbook, since problems are normally omitted from books that prefer to show perect cases. The chapters that show how to deal with membrane perforations and with bleeding from the posterior superior artery are very important for the reader.

This is a wonderful textbook that should add greatly to the body of knowledge in the dental and medical field of minimally invasive surgery. Congratulations to Dr.Heo and the other contributors to the barious chapters presented. It is a fine piece of work.

Dennis Tarnow DDS
Clinical Professor and Director of Implant Education
Columbia University College of Dental Medicine

Maxillary sinus augmentation has been documented as a safe and predictable procedure for gaining vertical bone height to facilitate implant placement in the atrophic posterior maxilae.

Nonetheless, the procedure remains challenging for many procticing clinicians who plant to incorporate this advanced surgical treatment modality into their daily practice. Dr.Young-Ku Heo developed the SCA (sinus crestal approach) and SLA (sinus lateral approach) kits back in 2008 that made it easier for implantologists adopting this sinus augmentation into their practice. The motivation for writing this book is to share Dr.Heo’s invention to help clinicians implement this into their daily practice.

Dr.Heo’s years of experience performing sinus augmentation is evidenced by the step by step, easy to understand procedures.

“Minimal Invasive Sinus Surgery – New Implant Treatment Protocols for the Posterior Maxlla” addresses many essential foundations needed for successful maxillary sinus augmentation procedure./ It covers topics such as anatomical structures of posterior maxilla, types of CMI fixation, CMI classification for sinus augementation, techiniques for SCA, SLA and management of sinus augmentation complications. The idea behind developing the SCA and SLA technique was presented. In addition, indications and precautions of using these kits in clinical procedures are also thoroughly discussed. This is a handbook not only for clinicians who want to employ these procedures into their daily practice but also for individuals who are starting to learn how to perform internal or lateral sinus approach.

Chapter 1 of this book talks about anatomical structure of the sinus which covers all aspects sinus related structure : Schneiderian membrane, bony ball, blood supply, sinus septum, pathology, ridge deficiencies and its related treatment modality, as well as a history of sinus augmentation procedure. It provides basic knowledge that a clinician should know before proceeding with this surgical modality. Chapter 2 introduces a new implant fixation concept in which implant fixation area was divided into 3 CMI area : Coronal, Middle and Inferior (apex) oif the implant, and its charting method including bone density of each fixation area, location of fixation, defect area, ITV value etc.. Chapter 3 discusses the innovative classification of sinus CMI fixation that Dr.Heo’s developed, which lays down the foundation for the SCA and SLA treatment. Chapter 4 and 5 highlight the SCA technique with solid case documentation. Clinicians can easily understand how to properly apply this technique based on a thorough understanding of the key factors (e.g., maximum amount of sinus elevation, membrane thickness, passive detachment of membrane, pressure threshold…etc) that minimize the membrane tear during the procedure. Lastly, Chapters 6 and 7 illustrate the concept of SLAapproach with step- by-step cases demonstration. Lastly, chapter 8 reveals scientific evidence for the SCA and SLA treatment modality and sinus CMI fixation protocols.

This book accumulates many experts years’ of experiences with well documented clinical cases to illustrate the concept and practical approacheds of how to perform the sinus augmentation procedures not only to achieve predictable outcome but also long-term tratment stablility. My congratulation and appreciation goes to Dr.Heo and all authors of the book for writing such a handy book that properly guides clinicians on how to use these techniques. By adopting these techniques and principles illustrated in the book, it improves our patient care, procedure safety, and benefit to patients who need this treatment. This is what we are all striving for when performing the sinus augmentation.

Hom-Lay Wang. DDS., MSD., Ph D
Professor and Director of Graduate Periodntics, Department of Periodontics and Oral Medicine, University of Michigna, School of Dentistry
Endowed Colegiate Professor, University of Michigan
Diplomate and Former Director & Chair, American Academy of Periodontology
Director, Academy of Osseointegration.